First-line therapy for COPD exacerbation includes:

• A. Oxygen therapy alone
• B. Inhaled corticosteroids only
• C. Systemic corticosteroids and short-acting bronchodilators
• D. Antibiotics alone

Answer: (C)

In COPD exacerbations, the priority is to rapidly relieve airway obstruction and reduce airway inflammation. The best first-line approach combines systemic corticosteroids to dampen inflammation and shorten recovery with short-acting bronchodilators to quickly open the airways and improve breathing. This pair directly targets the two main problems of an acute flare: bronchoconstriction and airway inflammation.

Oxygen therapy is important if the patient is hypoxemic, but it’s not a stand-alone treatment for the flare. Antibiotics are added if there are signs of a bacterial infection or increased sputum purulence, but they’re not used universally as first-line therapy. Inhaled corticosteroids alone don’t provide the rapid relief needed for an acute episode, and antibiotics alone don’t address bronchospasm or inflammation.